Healthcare Provider Details

I. General information

NPI: 1245364157
Provider Name (Legal Business Name): ANDREA COLETTE JOHNSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19204 NW US HIGHWAY 441
HIGH SPRINGS FL
32643-8783
US

IV. Provider business mailing address

PO BOX 3614
OCALA FL
34478-3614
US

V. Phone/Fax

Practice location:
  • Phone: 386-454-7746
  • Fax: 386-454-3034
Mailing address:
  • Phone: 352-817-7622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN9191956
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN9191956
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberAPRN9191956
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberARNP9191956
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9191956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: